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Osteochondrosis of the thoracic spine
Last reviewed: 08.07.2025
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Unlike discogenic syndromes of the lumbar and cervical levels, neurological complications of disc protrusions in the thoracic region remain the domain of clinical casuistry to this day.
The rarity of clinical manifestations of thoracic osteochondrosis is all the more obvious since the number of discs in this section is twice as large as the number of discs in both the cervical and lumbar sections. In addition, spondylographic signs of osteochondrosis are found in the thoracic section much more often than in the cervical and lumbar sections.
A certain role is played by the lower mobility of the thoracic vertebrae, as well as some features of the structure of the thoracic discs - the small thickness of the discs.
Physiological kyphosis of the thoracic region causes the concentration of maximum mechanical load on the anterior rather than posterior sections of the discs. As a consequence, there is a significantly higher probability of developing anterior rather than posterior hernias and osteophytes in the thoracic region, which are known to have no clinical significance.
Most often affected are Th 10, Th 11; Th 12. Protrusions of these three discs account for more than half of all cases of thoracic discopathy.
According to the location of the protrusions in the clinical picture, three main syndromes are distinguished:
- With medial hernia - symmetrical paraparesis and parahypesthesia without radicular syndromes;
- In case of mediolateral hernia - asymmetric spinal complex with predominance of damage on the side of the protruding disc, combined with radicular pain;
- Isolated radicular syndrome, usually caused by lateral hernia.
The first symptom of the disease is pain; less often the disease begins with numbness or weakness of the legs and even less often with pelvic disorders.
Depending on the location of the affected disc, the pain may be of the nature of intercostal, abdominal or inguinal neuralgia, or spread from the thoraco-abdominal region to the lower extremities.
Protective muscle contractures are observed in thoracic radiculosypathalgias significantly less frequently than in patients with discogenic lumbosciatica.
The pathogenetic basis for complications of thoracic protrusions are compression radiculo- and myelopathies. Discirculatory disorders are also of undoubted importance.
The presence of a large number of sympathetic fibers in the thoracic roots not only causes a specific vegetative coloring of thoracic radiculopathies, but can also cause the development of visceral pain and dyskinesia. For example, pseudoanginal attacks are observed with protrusions of the upper thoracic discs. A special variant of the pain syndrome associated with thoracic protrusions is "transversal" or "sagittal" pain in the chest and upper abdomen.
Vasomotor disorders of the lower extremities under the influence of prolonged spasm due to pain impulses are a common manifestation of thoracic osteochondrosis.
[ Reflex syndromes (thoracalgia)
Dorsalgia. Aching pain that intensifies with movement, when driving on an uneven road, or when cold. Localization of pain:
- in the interscapular region (burning in nature);
- in the intercostal spaces (the pain intensifies with forced inhalation and stretching).
Reflex tension of the paravertebral muscles is observed in dorsalgia, often asymmetrical, more pronounced on the convex side of the deformity.
ATTENTION! Tension in the paravertebral muscles is usually not as pronounced as at the cervical or lumbar level.
Anterior chest wall syndrome. The occurrence of pain may be caused by reflex tension and dystrophic changes:
- sternocleidomastoid muscles, originating on the sternum;
- scalene muscles attached to the I-II ribs;
- subclavian muscle (facilitated by the anomaly of the costoclavicular gap);
- pectoralis major muscle and other tissues of the anterior chest wall.
The pain intensifies with physical exertion on the chest muscles, when turning the head and torso.
ATTENTION! Angina pain most often occurs after emotional, general physical stress or eating.
The most painful areas are along the midclavicular line (level III-IV of the costochondral articulation) and along the free edge of the pectoralis major muscle.
Sternum syndrome (area of the beginning of the sternocleidomastoid muscle). Pain from the xiphoid process area spreads:
- in both subclavian regions;
- along the anterior inner surfaces of the upper limb girdle.
In the case of pathology of syndesmosis (synchondrosis) of the VII-X ribs, increased mobility of the end of one cartilage leads to its sliding and traumatization of nerve formations (receptors, trunks, including sympathetic ones). Irritation of the surrounding tissue causes aching pain, sometimes radiating to the shoulder joint area.